Provider Demographics
NPI:1164077822
Name:FAMILY MEDICINE - SLMG SOUTH, LLC
Entity type:Organization
Organization Name:FAMILY MEDICINE - SLMG SOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PHYSICIAN NETWORK
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-685-7804
Mailing Address - Street 1:121 SAINT LUKES CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3518
Mailing Address - Country:US
Mailing Address - Phone:636-685-7804
Mailing Address - Fax:
Practice Address - Street 1:1501 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-3809
Practice Address - Country:US
Practice Address - Phone:636-464-4000
Practice Address - Fax:636-529-0699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. LUKES MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-08
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty